Archive for the 'Science and Medicine' Category

Every now and then we get a public peek into the mind of a crank or pseudoscientist. This is not to say that they don’t utter complete nonsense often, but usually in public they try to put a sanitized and rational face on their quackery. An unfiltered rant can be refreshing and illuminating.

Recently a homeopath, Mary English, wrote such a public rant against Simon Singh, who is a science communicator and promoter of rationality. What has English so riled is the fact that Singh is threatening to sue the National Health Service (NHS) for wasting taxpayer money by funding homeopathy.

In February 2015, The Good Thinking Society, working with Bindmans LLP, wrote to Liverpool CCG (Clinical Commissioning Group) in order to highlight and challenge the CCG’s decision to approve spending on homeopathic treatments – a decision we believe to be unlawful, and contrary to the best interest of local patients. In April 2015, Liverpool CCG conceded our challenge and agreed to make a fresh decision on the issue.

Last year two similar cases in Canada came to public attention – both involved young girls with terminal blood cancer, but ones that are very treatable. Their cancers would almost certainly result in death if they go untreated, and yet they would have about an 85% chance of survival with standard treatment. Both girls were also members of the First Nations, natives with a history of not being treated well by the Canadian government.

In both cases the family wanted to seek “traditional” treatment instead of completing chemotherapy. However, the “traditional” treatment they were seeking was holistic garbage peddled by a charlatan (who is white, and not a native) in Florida, Brian Clement. Clement is not a doctor, but claims to treat cancer with the usual assortment of popular quackery today. Recently the state of Florida accused him of practicing medicine without a license, but they then dropped the case for unknown reasons. I guess Florida just doesn’t have the political will to protect the public from harmful nonsense.

Clement’s false hope has already claimed the life of one of the girls, 11 year-old Makayla Sault died of her leukemia in January. Her mother was literally lured away from continuing chemotherapy by the promises of Clement.

What is most interesting is that the Canadian courts had an opportunity to intervene and to protect these children. They failed with regard to Sault and it is now too late for her. The second girl, whose name is not public, also was allowed to forgo chemotherapy to pursue traditional Floridian quackery. In November 2014 Ontario court Judge Gethin Edward ruled that the family has the right to deny their daughter standard medical treatment. This was done to respect the rights of the First Nations. I argued at the time, while I understand this is a sensitive issue, the rights of a young girl to live trumps everything else in such cases, and I felt this was a profound failure on the part of Judge Edward.

Eloise Aimee Parry, 21, died on April 12 after taking 8 diet pills she bought online. The pills contained 2,4-dinitrophenol (DNP), which is essentially an illegal weight loss aid. The case illustrates the failure of current regulations to protect the public from potentially dangerous drugs. There are many factors that contribute to this failure.

First, some background on DNP

DNP is a powerful uncoupler of oxidative phosphorylation – it allows protons to leak across the mitochondrial membrane, bypassing ATP synthesis. Mitochondria are the energy factories of cells; they make energy using oxygen in a process called oxidative phosphorylation, essentially adding a phosphate atom to ADP to make ATP. ATP are the batteries of cells, they store energy in their phosphate bonds and then can release that energy to drive the reactions necessary for cell functions.

In a recent editorial David Brooks makes the point that privacy is important and we should not relinquish it lightly. Among other benefits of privacy, he states:

There has to be a zone where half-formed thoughts and delicate emotions can grow and evolve, without being exposed to the harsh glare of public judgment. There has to be a place where you can be free to develop ideas and convictions away from the pressure to conform.

I agree with this. The law also recognizes this, which is why there is automatic privilege between married individuals. This also came up in discussions of whether or not conversations between the president and his advisers should be private or public, with many making the point that the public’s interests are probably best served if their advice were candid and uncensored. We also recognize the need for attorney-client privilege and the confidentiality of the physician-patient relationship.

At the same time there are benefits to transparency and there are situations in which the public interest is best served by open discussion, even leaking information that some would want to keep private. For example, government communications at some level should be transparent, hence the mini-scandal surrounding Clinton’s e-mails. Courtroom testimony is public, but the deliberations of the jury are private.

Science is one of those things that should be, in my opinion, completely transparent and public. An individual scientist is free to keep their private thoughts private, but scientific deliberations, publications, research, and policy should be not only public but easily accessible.

The FDA regulates food, drugs, medical devices, supplements, and cosmetics for the purpose of protecting the public health and safety. Congress created the FDA and determines its powers. In the 1938 FDA act, one Senator, Royal Copeland, who was a physician and homeopath, included in the bill that the provision that the Homeopathic Pharmacopeia of the United States (HPUS) would be included in the list of official drugs.

What this means exactly is that homeopathic products are automatically considered drugs by the FDA. Further, any new homeopathic product added to the HPUS in a supplement also counts. All homeopaths have to do, therefore, to get a homeopathic product listed as a drug by the FDA is write it down in one of their supplements to the HPUS. That’s it. No research is necessary, no assurance of safety or efficacy.

Australia Prime Minister Tony Abbott has just announced a new policy that will go into effect January 2016 – the “no jab, no pay” policy. Under this policy parents who refuse to vaccinate their children will lose tax exemptions for children. This could cost them up to $11,000 per year (I have also seen estimates of up to $15,000) per child.

This new policy is reported to have bipartisan support and is supported by the Australian Medical Association.

The new policy would not apply to medical exemptions or religious exemptions, but the latter is enforced as a very narrow exemption.

Antivax parents are, of course, protesting, arguing that the new policy infringes on their rights as parents. But does it? The antvax community often makes the argument that they have the right as parents to make medical decisions for their children and the government cannot force them to vaccinate.

It seems that the regulation of supplements, homeopathy, and “natural” products in Canada is as bad as the US. The Canadian Broadcasting Corporation (CBC, the equivalent of NPR and PBS in the US) recently conducted a demonstration of just how worthless and deceptive the regulations are.

They created a fake treatment called “Nighton” which they claimed treated fever, pain, and inflammation in children and infants. They then applied to the government for a Natural Product License. On the application they checked all the appropriate boxes amd submitted as evidence copied pages from a 1902 homeopathic reference book. That was it. Five months later their fictitious product was approved as “safe and effective.”

What this means is that when the Canadian government approves a natural product as safe and effective, it is completely meaningless. It is essentially a license to lie to the public about a health product.

It is reasonable to assume that many if not most of the public, if they see a product on the pharmacy shelf with the label, “licensed as safe and effective for fever, pain, and inflammation,” with an official government issued product number, that some sort of testing and quality assurance was involved.

I was recently pointed to an excellent article by an Irish journalist, Jonathan McCrea, about homeopathy. He discussed the topic on his radio show, and was highly critical of the practice. In response a homeopath wrote in a letter complaining that the shows was too negative, and McCrea wrote a nice reply pointing out the scientific evidence. He quoted science-based medicine extensively, as well as systematic reviews.

It’s wonderful to see a science journalist who is not a scientist themselves do such a great job. As he explained himself in the reply, a good journalist will reflect the consensus of expert opinion. He also pointed out the dangers in medical nonsense and clearly understands his duty as a journalist when reporting on such issues – so good for him.

Here is the money quote from the homeopath:

What I would like to point out to your presenters is that never, in all their dismissal of homeopathy, do they seem to take into consideration the homeopaths who practice this particular brand of ‘heresy’ (heresy according to their own particular view of the world that is). If it is nonsense as they claim, then we are all either stupid, deluded or charlatans who take people’s money for something which we know does nothing. I may be many things but I am neither stupid, deluded nor a charlatan as anyone who knows me will verify. Neither are those thousands of doctors and vets who have changed from using conventional medicine to homeopathy. No homeopath or user of homeopathy comes to it from ‘belief’. We come to it from trying it, sometimes from curiosity, but often in desperation when other things haven’t worked. Then when we see it works we try it again. Then it works again and we try it more often, and it keeps working. Not every time, any more than antibiotics, or any other medicine works every time. But enough, more than enough to make us trust it.

This is a typical response – the appeal to anecdotal evidence. Clearly this homeopath does not understand the scientific position. She sets up an interesting forced choice straw man, that critics think homeopaths are either stupid, deluded, or charlatans. First, these are not mutually exclusive states. But then she equates these possibilities to using treatments which “we know does nothing.” That is a non-sequitur, however. If a homeopath is stupid or deluded then they don’t know that what they are using does nothing.

I want the public to fully understand what naturopaths are, because I don’t think that they do. This is a situation common to many cults and pseudosciences – there is a superficial layer of reality that represents the public face of the group, largely crafted for marketing purposes, and then there is the deeper layer of utter nonsense that most people don’t see. Homeopathy is a great example. Unless you are a skeptic or true believer, chances are you think homeopathy is some form of herbalism, rather than the magic potions that it is.

Naturopathy is similar. The superficial marketing level presentation of naturopathy is that its practitioners are medically trained and emphasize nutrition, lifestyle, and natural remedies. I attended a lecture at Yale by a naturopath who summarized their training as, “Everything you get in medical school, plus nutrition.” (The first claim is patently wrong, and the second falsely assumes that medical training does not include nutrition.)

The marketing, however, is working. After a recent article about naturopathy we posted on our Facebook page we had this comment:

How can you stop believing whole food, herbs, sunshine, fresh air, good water, exercise and human touch (which are the foundation of naturopathic medicine) are worse for you than allopathic poisons?

Last year David Gorski and I published an article in which we argue that it is a waste of resources and ultimately counterproductive to conduct clinical trials of a treatment that is so scientifically implausible it might as well be “magic.” Homeopathy, for example, fits squarely into this category. The alternative medicine (CAM) community did not respond favorably to our arguments.

A recent article by Sunita Vohra and Heather Boon directly critiques our article. Vohra and Boon are both involved in homeopathy research, so this is no surprise. In their brief article they essentially repeat the standard CAM talking points about scientific research, without really countering the position that David and I have described. In their article, in my opinion, they demonstrate the utter intellectual bankruptcy of the CAM position. They repeat points that have been deconstructed years ago, without ever addressing the counterpoints.

The core of the disagreement is about the relative role of various kinds of scientific research in evaluating medical therapies. The position of science-based medicine (SBM) is that rigorous efficacy trials are required to truly know if a treatment is safe and effective (that aspect of our position we share with standard evidence-based medicine or EBM). Further, this clinical evidence must be put into the context of all the rest of science, right down to basic laws of physics, summarized as an overall scientific judgement about the plausibility of the treatment. This basic science plausibility should also be used to guide the expenditure of our limited resources in conducting expensive and resource-draining clinical trials. At the same time, solid evidence from clinical trials can inform basic science by suggesting possible biological mechanisms.